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Pharmacology · chapter 31 · Hyperacidity and Antiulcer Drugs

Pepsin Inhibitors and Prostaglandin Analogues

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Pepsin can damage the stomach lining

    A low gastric pH of 1.5–2 activates pepsin. However, pepsin may cause erosive damage to the mucosal lining of the stomach.

  2. What mucosal protectants do

    To mitigate the potential harm caused by pepsin, mucosal protectants are employed. These agents serve a dual purpose by reducing both gastric acid production and pepsin activity.

  3. How sucralfate coats ulcers

    When ingested, it transforms into a viscous substance that adheres to ulcerated areas, creating a protective barrier on the mucosal lining of the stomach and duodenum.

  4. Where sucralfate works best

    Sucralfate is especially effective with duodenal ulcers, ulcers due to aspirin use, and chemotherapy-induced mucositis. It may also be beneficial for stress ulcer prophylaxis.

  5. Sucralfate timing

    To maximize effectiveness, it should be taken 4 times a day, approximately 60 minutes before meals and at bedtime.

  6. Separate sucralfate from antacids

    When used alongside antacids in antiulcer therapy, it's advisable to administer antacids 30 minutes before or after sucralfate.

  7. Separate sucralfate from other drugs

    Additionally, due to its adhesive properties, sucralfate should be taken at least 2 hours before or after medications such as quinolones, digoxin, phenytoin, and tetracycline to prevent any interference with their effectiveness.

  8. What prostaglandin analogues do

    Synthetic prostaglandin analogues, in a similar manner, act as mucosal protectants by decreasing acid secretions while increasing the secretion of bicarbonate and protective mucus.

  9. Misoprostol with NSAIDs

    Misoprostol is available in tablets that are administered with food 4 times a day alongside NSAID therapy.

  10. Mucosal protectant adverse effects

    Common adverse effects of mucosal protectants include hyperglycemia, dizziness, insomnia, and GI symptoms such as nausea, vomiting, diarrhea, and flatulence.

  11. Prostaglandin analogue adverse effects

    Typical adverse effects of prostaglandin analogues include headache, diarrhea or constipation, abdominal pain, flatulence, and gynecological symptoms such as dysmenorrhea, vaginal bleeding, uterine contractions, and postmenopausal bleeding.

  12. Misoprostol in pregnancy

    Contraindications include hypersensitivity to prostaglandins and pregnancy. Misoprostol may endanger pregnancy (may cause abortion) and cause harm to the fetus when administered to a pregnant client.

  13. Report bleeding or cramping

    When using misoprostol, report symptoms of abnormal vaginal bleeding or uterine cramping to the health care provider as these can represent serious adverse effects.

  14. Misoprostol black box warning

    Misoprostol can cause spontaneous abortion, premature birth, or birth defects.

Terms to know

Pepsin
Pepsin is a gastric enzyme that breaks down and supports the digestion of proteins from foods.
Sucralfate
Sucralfate is classified as a mucosal protectant or coating agent.
Prostaglandins
Prostaglandins are naturally occurring compounds present in the GI tract that protect the mucosal lining of the stomach and duodenum.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

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Every question here, with the answer

  1. A client with a duodenal ulcer is prescribed sucralfate four times a day. When should the nurse schedule the doses?

    1. With each meal and at bedtime
    2. About 60 minutes before meals and at bedtime
    3. Once in the morning with an antacid
    4. Immediately after meals only

    Answer: About 60 minutes before meals and at bedtime

    Sucralfate works best taken 4 times a day, about 60 minutes before meals and at bedtime. Giving it with an antacid at the same time interferes; antacids are given 30 minutes before or after.

  2. A client takes digoxin and has just been prescribed sucralfate. What should the nurse do?

    1. Crush both and give them in applesauce.
    2. Give sucralfate at least 2 hours before or after the digoxin.
    3. Give both drugs together to improve adherence.
    4. Stop the digoxin while the client is on sucralfate.

    Answer: Give sucralfate at least 2 hours before or after the digoxin.

    Because of its adhesive properties, sucralfate is taken at least 2 hours before or after drugs such as digoxin, quinolones, phenytoin and tetracycline so it does not interfere with them. Stopping digoxin is not indicated.

  3. A 28-year-old client taking long-term NSAIDs is prescribed misoprostol. Which teaching is most important?

    1. Take misoprostol on an empty stomach.
    2. Stop the NSAID when starting misoprostol.
    3. Misoprostol can cause spontaneous abortion, premature birth, or birth defects.
    4. Misoprostol causes weight gain.

    Answer: Misoprostol can cause spontaneous abortion, premature birth, or birth defects.

    The black box warning states misoprostol can cause spontaneous abortion, premature birth or birth defects, and clients of childbearing age must be told of the fetal risk. It is taken with food alongside NSAID therapy, not instead of it.

  4. A client is taking misoprostol. Which symptoms should the nurse teach the client to report? Select all that apply.

    1. Abnormal vaginal bleeding
    2. Postmenopausal bleeding
    3. Uterine cramping
    4. Relief of heartburn
    5. Improved appetite

    Answer: Abnormal vaginal bleeding, Postmenopausal bleeding, Uterine cramping

    Abnormal vaginal bleeding and uterine cramping can be serious adverse effects of misoprostol, and postmenopausal bleeding is a listed gynecological effect. Improved appetite and relief of heartburn are not adverse effects.

  5. Which statements about how sucralfate works are accurate? Select all that apply.

    1. It must be chewed with food to activate.
    2. It creates a protective barrier on the stomach and duodenal lining.
    3. It shields ulcers from pepsin and hydrochloric acid.
    4. It works by increasing gastric acid production.
    5. It forms a viscous substance that sticks to ulcerated areas.

    Answer: It creates a protective barrier on the stomach and duodenal lining., It shields ulcers from pepsin and hydrochloric acid., It forms a viscous substance that sticks to ulcerated areas.

    Sucralfate becomes a viscous paste that adheres to ulcers and forms a barrier against pepsin and acid for up to 6 hours. It does not increase acid, and it is taken on an empty stomach before meals.

  6. A client with diabetes has started sucralfate. Which adverse effect should the nurse monitor for?

    1. Hyperglycemia
    2. Hypokalemia
    3. Bradycardia
    4. Hair loss

    Answer: Hyperglycemia

    Hyperglycemia is a common adverse effect of mucosal protectants such as sucralfate, which matters for a client with diabetes. The other options are not listed for sucralfate.

Where every quote comes from

Section 31.3 Pepsin Inhibitors and Prostaglandin Analogues of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.